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Martins Coelho Junior VDP, Alvarado AM, Fessler RG. A novel endoscope-port unit for lumbar microendoscopic surgery: a single-center case series review. Neurosurg Rev 2024; 47:356. [PMID: 39060770 DOI: 10.1007/s10143-024-02588-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 06/02/2024] [Accepted: 07/08/2024] [Indexed: 07/28/2024]
Abstract
Minimally invasive spinal surgery has shown benefits not only from a clinical standpoint but also in some cost-effectiveness metrics. Microendoscopic procedures combine optical advantages of endoscopy with the preservation of bimanual surgical maneuvers that are not feasible with full percutaneous endoscopic procedures. TELIGEN is a new endoscopic platform designed to optimize these operations. Our aim was to present a retrospective review of surgical data from the first consecutive cases applying this device in our institution and describe some of its technical details. 25 patients have underwent procedures using this device at our institution to the date, with a mean follow-up of 341.7 ± 45.1 days. 17 decompression-only procedures, including microendoscopic discectomies (MED) and decompression of stenosis (MEDS), with or without foraminotomies (± MEF) and 8 microendoscopic transforaminal lumbar interbody fusions (ME-TLIF) were performed. Mean age and body mass index (BMI) were respectively 58.8 ± 17.4 years and 27.6 ± 5.3 kg/m2. Estimated blood loss (13 ± 4.8, 12.8 ± 6.98 and 76.3 ± 35.02 mL), postoperative length of hospital stay (11.2 ± 21.74, 22.1 ± 26.85 and 80.7 ± 44.60 h), operative time (130.3 ± 58.53, 121 ± 33.90 and 241.5 ± 45.27 min) and cumulative intraprocedural radiation dose (14.2 ± 6.36, 15.4 ± 12.17 and 72.8 ± 12.26 mGy) are reported in this paper for MED ± MEF, MEDS ± MEF and ME-TLIF, respectively. TELIGEN affords an expanded surgical field of view with unique engineered benefits that provide a promissing platform to enhance minimally invasive spine surgery.
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Affiliation(s)
- Vicente de Paulo Martins Coelho Junior
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA.
- Department of Neurological Surgery, Ohio State University Wexner Medical Center, 410 W 10th Ave, Columbus, OH, 43210, USA.
| | - Anthony M Alvarado
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
| | - Richard G Fessler
- Department of Neurosurgery, Rush University Medical Center, Chicago, IL, USA
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Liu C, Zhang W, Wang C, Hu B, Wang K, Feng Y, Li L, Xu W, Si H. Comparison of one-hole split endoscopic discectomy and microendoscopic discectomy in the treatment of lumbar disk herniation: a one-year retrospective cohort study. J Orthop Surg Res 2024; 19:123. [PMID: 38317253 PMCID: PMC10845564 DOI: 10.1186/s13018-024-04574-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/20/2024] [Indexed: 02/07/2024] Open
Abstract
BACKGROUND We aim to compare and assess the surgical parameters and follow-up information of one-hole split endoscopic discectomy (OSE) and microendoscopic discectomy (MED) in the treatment of LDH. METHODS This study included 154 patients with degenerative lumbar disk disease. Sixty-eight patients underwent OSE and 86 patients MED. The VAS score for lower back and lower limb radiation pain, ODI score, modified MacNab score, estimated blood loss (EBL), length of the incision, amount of C-reactive protein, and recurrence and complication rates were examined as indicators for clinical outcomes and adverse events. RESULTS After surgery, the VAS and ODI scores in the two groups significantly decreased. On the third day after surgery, the VAS and ODI scores of the OSE group were significantly better than those of the MED group. The VAS and ODI scores preoperatively and at 1 month, 3 months, 6 months, and 12 months following the procedure did not substantially vary between the two groups. There was less EBL and a shorter incision with OSE than with MED. There was no significant difference in the rate of complications between the two groups. CONCLUSION Compared with MED, OSE is a new alternative option for LDH that can achieve similar and satisfactory clinical outcomes. Furthermore, OSE has many advantages, including less EBL and a smaller incision. Further clinical studies are needed to confirm the effectiveness of OSE.
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Affiliation(s)
- Chen Liu
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Wencan Zhang
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China
| | - Chongyi Wang
- Department of Orthopedics, Qilu Hospital (Qingdao), Shandong University, Qingdao, 266035, Shandong, People's Republic of China
| | - Bingtao Hu
- Department of Orthopedics, Qilu Hospital (Qingdao), Shandong University, Qingdao, 266035, Shandong, People's Republic of China
| | - Kaibin Wang
- Department of Orthopedics, Qilu Hospital (Qingdao), Shandong University, Qingdao, 266035, Shandong, People's Republic of China
| | - Yunze Feng
- Department of Orthopedics, Qilu Hospital (Qingdao), Shandong University, Qingdao, 266035, Shandong, People's Republic of China
| | - Le Li
- Department of Orthopedics, Qilu Hospital (Qingdao), Shandong University, Qingdao, 266035, Shandong, People's Republic of China
| | - Wanlong Xu
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China.
| | - Haipeng Si
- Department of Orthopedics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, 250012, Shandong, People's Republic of China.
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Gerling MC, Baker M, Stanton E, Chaladoff E, Buser Z. Nerve root retraction time during lumbar endoscopic discectomy: association with new onset radiculitis, a post-operative neurologic complication. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:126-132. [PMID: 37747545 DOI: 10.1007/s00586-023-07952-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 08/31/2023] [Accepted: 09/11/2023] [Indexed: 09/26/2023]
Abstract
PURPOSE To evaluate the relationship between nerve root retraction time, post-operative radiculitis and patient reported outcomes. METHODS Patients who underwent single- or multi-level lumbar discectomy between 2020 and 2022 for lumbar disk herniations were prospectively followed with pre-operative, interoperative and post-operative variables including radiculitis and patient reported outcomes including VAS, ODI and CAT domains Pain interference, Pain intensity and Physical function. Intraoperative nerve root retraction time was recorded. Paired sample two-tailed t-test and multivariate regression were utilized with p < 0.05 being significant. RESULTS A total of 157 patients who underwent single- or multi-level endoscopic lumbar discectomy. Average patient age was 44 years, and 64% were male patients. Nerve retraction time ranged from 4 to 15 min. Eighteen percent reported new radiculitis at 2-weeks post-operatively. In patients with new-onset radiculitis 79.2% reported significantly worse VAS leg at 2 weeks post-operative (4.2 vs. 8.3, p < 0.001) compared to 12.5% who had improved VAS leg (9.3 vs. 7, p = 0.1181). Patients with radiculitis and worse VAS scores had substantially longer nerve retraction time (13.8 ± 7.5 min) than patients with improved VAS leg (6.7 ± 1.2 min). At 6 months, patients with longer nerve retraction time had no significant improvement in the ODI or CAT compared to the baseline. CONCLUSIONS This is the first study in discectomy literature to show that new onset radiculitis and poorer outcomes in VAS leg correlate with longer nerve retraction time at early and later time points.
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Affiliation(s)
- Michael C Gerling
- Gerling Institute, Brooklyn, NY, USA
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, 94 9th Street, Unit 1-222, Brooklyn, NY, 11215, USA
| | | | - Eloise Stanton
- Keck School of Medicine, University of Southern California, Los Angeles, USA
| | | | - Zorica Buser
- Gerling Institute, Brooklyn, NY, USA.
- Department of Orthopedic Surgery, NYU Grossman School of Medicine, 94 9th Street, Unit 1-222, Brooklyn, NY, 11215, USA.
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Helgeson MD, Pisano AJ, Fredericks DR, Wagner SC. What's New in Spine Surgery. J Bone Joint Surg Am 2023:00004623-990000000-00792. [PMID: 37141447 DOI: 10.2106/jbjs.23.00125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Melvin D Helgeson
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Alfred J Pisano
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Donald R Fredericks
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
| | - Scott C Wagner
- Department of Orthopaedics, Walter Reed National Military Medical Center, Bethesda, Maryland
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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Cheng X, Bao B, Wu Y, Cheng Y, Xu C, Ye Y, Dou C, Chen B, Yan H, Tang J. Clinical comparison of percutaneous transforaminal endoscopic discectomy and unilateral biportal endoscopic discectomy for single-level lumbar disc herniation. Front Surg 2023; 9:1107883. [PMID: 36726945 PMCID: PMC9884965 DOI: 10.3389/fsurg.2022.1107883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 12/30/2022] [Indexed: 01/19/2023] Open
Abstract
Purpose To compare the clinical outcomes of percutaneous transforaminal endoscopic discectomy (PTED) and unilateral biportal endoscopic discectomy (UBE) for the treatment of single-level lumbar disc herniation (LDH). Materials and methods From January 2020 to November 2021, 62 patients with single-level LDH were retrospectively reviewed. All patients underwent spinal surgeries at the Affiliated Hospital of Chengde Medical University and Beijing Tongren Hospital, Capital Medical University. Among them, 30 patients were treated with UBE, and 32 were treated with PTED. The patients were followed up for at least one year. Patient demographics and perioperative outcomes were reviewed before and after surgery. The Oswestry Disability Index (ODI), visual analog scale (VAS) for back pain and leg pain, and modified MacNab criteria were used to evaluate the clinical outcomes. x-ray examinations were performed one year after surgery to assess the stability of the lumbar spine. Results The mean ages in the UBE and PTED groups were 46.7 years and 48.0 years, respectively. Compared to the UBE group, the PTED group had better VAS scores for back pain at 1 and 7 days after surgery (3.06 ± 0.80 vs. 4.03 ± 0.81, P < 0.05; 2.81 ± 0.60 vs. 3.70 ± 0.79, P < 0.05). The UBE and PTED groups demonstrated significant improvements in the VAS score for leg pain and ODI score, and no significant differences were found between the groups at any time after the first month (P > 0.05). Although the good-to-excellent rate of the modified MacNab criteria in the UBE group was similar to that in the PTED group (86.7% vs. 87.5%, P > 0.05), PTED was advantageous in terms of the operation time, estimated blood loss, incision length, and length of postoperative hospital stay. Conclusions Both UBE and PTED have favorable outcomes in patients with single-level LDH. However, PTED is superior to UBE in terms of short-term postoperative back pain relief and perioperative quality of life.
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Affiliation(s)
- Xiaokang Cheng
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, China,Department of Orthopedics, Chengde Medical University Affiliated Hospital, Chengde, China
| | - Beixi Bao
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuxuan Wu
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yuanpei Cheng
- Department of Orthopedics, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Chunyang Xu
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yang Ye
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chentao Dou
- Department of Orthopedics, Chengde Medical University Affiliated Hospital, Chengde, China
| | - Bin Chen
- Department of Orthopedics, Chengde Medical University Affiliated Hospital, Chengde, China
| | - Hui Yan
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Jiaguang Tang
- Department of Orthopedics, Beijing Tongren Hospital, Capital Medical University, Beijing, China,Correspondence: Jiaguang Tang
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Kong W, Du Q, Xin Z, Cao G, Liu D, Wei Y, Liao W. Percutaneous fully endoscopic surgical management of the ruptured epidural catheter: Rescue of the novice anesthesiologist from his dilemma. Front Surg 2022; 9:915133. [PMID: 36303856 PMCID: PMC9592838 DOI: 10.3389/fsurg.2022.915133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/13/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Epidural nerve block and analgesia are basic anesthetic techniques for anesthesia. Epidural catheter rupture and partial retention are adverse events and rare complications of epidural catheterization technique. The probability of occurrence when applied by novice doctors is high. Removal of the residual catheter by conventional surgery causes more trauma and bleeding, slows recovery, and may causes medical disputes. We hypothesized that percutaneous spinal endoscopy a safe and effective remediation technique. This study was to analyze the efficacy and safety of removing the residual dural catheter by a percutaneous full-endoscopic technique(PFET) and discuss the clinical technique and precautions. METHODS This was a retrospective analysis of 7 patients with ruptured epidural catheters treated in our department from October 2015 to October 2019 using the PFET to remove the remaining epidural catheter. The operation time, intraoperative bleeding volume, surgical complications, and neurological symptoms before and after surgery were recorded. The Self-Rating Anxiety Scale (SAS) was used to assess the anxiety level of the anesthesiologist and the patient before and after the catheter removal operation, and the postoperative low back pain VAS score was recorded. RESULTS The remaining epidural catheter was successfully removed from all 7 patients. The operation time was 54.14 ± 14.45 (32-78) minutes, and the intraoperative blood loss was 9.134 ± 3.078 (5-15) ml. There were no cases of dural damage, cerebrospinal fluid leakage, sensorimotor dysfunction of the lower limbs, or bowel dysfunction. The anxiety symptoms of the patient and the anesthesiologist disappeared after removal of the residual epidural catheter. The patients' postoperative back pain VAS score was 0 to 2 points. CONCLUSION PFET is a safe and effective minimally invasive technique for removing residual epidural catheters. It causes less trauma and less bleeding, allows a faster recovery. It does not affect the recovery of patients from other surgical operations and reduces both medical risks and medical costs. At the same time, it avoids or reduces the occurrence of medical disputes and eliminates the pressure on novice anesthesiologists regarding similar adverse events.
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Affiliation(s)
- Weijun Kong
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China,Department of Orthopedic Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Qian Du
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Zhijun Xin
- Department of Orthopedic Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Guangru Cao
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China,Department of Orthopedic Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Dexing Liu
- Department of Anesthesia and Perioperative Care, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Yiyong Wei
- Department of Anesthesia and Perioperative Care, The Affiliated Hospital of Zunyi Medical University, Zunyi, China
| | - Wenbo Liao
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi, China,Department of Orthopedic Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, China,Correspondence: Wenbo Liao
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